Two Cases of Cerebral Venous Thrombosis with High Signal Intensity of Intravascular Clots on Diffusion Weighted Image

High signal intensity on diffusion-weighted image (DWI) at the site of venous occlusion has previously been reported in cerebral venous thrombosis (CVT). The frequency and diagnostic value of these signal changes in CVT were unknown. Some authors suggest that the presence of high signal intensity on DWI in occluded veins might help diagnose CVT and suggest low rate of recanalization. We experienced two cases of CVT with high signal intensity at the site of intravascular clot on DWI.

Cavernous Hemangioma in the Middle Cranial Fossa & Cavernous Sinus

Extracerebral cavernous hemangiomas are rare vascular tumors that are very difficult to remove because of severe intraoperative bleeding. We report a case of 57-year-old male with extracerebral cavernous hemangioma with review of 126 cases in the literature. Patient presented with blurred vision, diplopia, numbness on the left side of his face. Magnetic resonance imaging revealed a well defined mass of 3 x 4 x 3 cm size with heterogenous iso-or hypointensity on T1-weighted image showing strong homogenous contrast enhancement and marked hyperintensity on T2-weighted image. Digital subtraction angiography(DSA) revealed a faint tumor blush by feeders from the left internal carotid artery(ICA) and left external carotid artery(ECA) in the delayed phase. Even with profuse intratumoral bleeding, near total removal was achieved. In addition to preoperative neurologic deficits such as ophthalmoplegia, facial numbness in the V1-2 dermatomes, ptosis appeared postoperatively.

Surgical treatment of cervical ossification of posterior longitudinal ligament with high-signal intensity zone and analysis of the curative effect / 中国矫形外科杂志

[Objective]To observe and analyze the clinical results of ossification of posterior longitudinal ligament(OPLL) combined with high-signal intensity zone(HIZ) change. [Methods]Forty patients with OPLL combined with HIZ were treated from March 2004 to March 2008.Anterior approach surgery was given to 19 cases as group A and posterior approach surgery was given to 21 cases as group P.All cases were followed up.The pre-and post-operative JOA17 scores and improvement ratio were evaluated.[Results]The mean follow-up time were(19.5?3.4) months in group A and(20.3?4.5) months in group P.The mean improvement ratio were(56.2?8.4)% in group A and(52.2?12.2)% in group P.There were no statistical differences between those of groups A and P.Mean JOA scores at last follow-up were(12.8?0.9) in group A and(11.5?1.6) in group P,with significantly difference.[Conclusion]Treatment of OPLL combined with HIZ is a high risk procedure with limited recovery in neoro-function.Good surgical result could be got with correct judgement of type and location of OPLL,occupation ratio of spinal canal and selection of approach.

A study on manganese health hazards among experienced welders / 예방의학회지

This study was conducted to evaluate the health hazards and to develop early diagnostic methods of the manganism in experienced welders and to know the meaning of signal intensities on the brain Magnetic Resonance images. It was carried out from December 1996 to February 1997 with 277 male welders, the duration of welding was at least 5 years or more. The study was consisted of a questionnaire, physical examination and measurements of blood and urine manganese concentrations. Brain Magnetic Resonance imaging was done on 19 study subjects by random sampling. As the duration of welding increases, the positive rates of clinical symptoms, neurological examinations and blood manganese concentrations were also increased. However, physical examinations and urine manganese concentrations were not statistically significant with the duration of welding. Authors couldn't observe any Parkinsonism-like diseases. There were statistically significant correlations between duration of welding and blood manganese concentrations(r=0.16, p<0.01). There were not statistically significant correlations between duration of welding and urine manganese concentrations(r=0.06). There were statistically significant correlations between blood and urine manganese concentrations(r=0.34, p<0.01). By viewing brain Magnetic Resonance images, 13 welders(68.4 %) among 19 welders were found to have signal intensities. The positive rates of clinical symptoms, physical examinations, neurological examinations and blood and urine manganese concentrations were not statistically different between those with signal intensities and those without signal intensities. We would like to suggest that some non-specific clinical symptoms and neurological signs are correlated with the duration of welding but any Parkinsonism-like diseases had not been observed with these welders. Next we suggest that the high signal intensities on T1WI of brain Magnetic Resonance images are not the sign of manganese intoxication but the sign of manganese deposition.

An Association between Brain MRI and Neurologic Findings in Welders Exposed to Manganese Fume / 대한산업의학회지

This study was carried out to investigate the relationship between brain magnetic resonance imaging (MRI) and neurological findings in welders exposed to manganese fume. Thirty five welders from a bus manufacturing factory who were occupationally exposed to low dose manganese fume were examined. We collected the information on the demo graphic factors and welding careers. Laboratory investigations included blood and urine manganese concentration and blood chemistry. Brain MRI was checked, and high signal intensity of the globus pallidus was graded from 0 to 3 compared to the white matter of the frontal lobe. Neurologic examination wart carried out. The results were as follows ; 1. The mean age of workers was 48.3+/-5.7 years, mean duration of welding was 21.4 +/-5.6 Years. 2. On brain MRI, high signal intensity in the globes pallidus was observed in 27 workers (77.1%) Among them, 18 cases (66.7%) showed remarkably high signal intensity (grade 2) Mean concentration of blood manganese was higher in those with high signal intensity and correlated to the grade of high signal intensity (p=0.02) 3. On neurologic examination, no workers showed the finding of typical parkinsonism. But 11 workers (31.4%) showed subtle neurological abnormalities such as gait without associated arm movement, postural instability, intention tremor, and so on. Blood manganese concentration of neurologically abnormal group was 2.4+/-0.7 microgram/dL, which was significantly higher, compared to 1.8+/-0.7 microgram/dL of neurologically normal group (p=0.03). 4. Among 27 workers who showed high signal intensity on brain MRI, 10 workers (37%) were neurologically abnormal. Higher grade of signal intensity on globus pallidus showed higher rate of neurologic abnormality (p<0.05) Especially postural instability and gait without associated arm movement were prominent findings. These bindings suggest that high signal intensity on brain MRI might be associated with a prodromal sign of manganese intoxication. Careful neurologic examination should be tool lowed up on welders showing high signal intensity in the golbus pallidus of brain MRI.

Three Cases of High Signal Intensity by Brain Magnetic Resonance Imaging in CO2 arc Welders / 대한산업의학회지

We experienced three cases of high signal intensity observed by Brain Magnetic Resonance Imaging in CO2 arc welders of steel-frame manufacturing industry. Case 1 was a 35 years old man who has been an CO2 arc welder for 10 years, admitted a sudden onset of tonic clonic seizure. He complained fever, chilling and myalgia since 3 days before admission. On admission, in the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.17 microgram/dL, 22.00 microgram/l and 31.25 ppm respectively. Case 2 was a 35 years old man who has been an CO2 arc welder for 20 years. On admission, He complained fatigue, numbness and weakness of extremities, and decrease of libido. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 6.34 microgram/dL, 14.62 microgram/l and 57.87 ppm respectively. In neurologic examination, Palmo-mentis reflex and Myerson sign were observed. Case 3 was a 33 years old man who has been an CO2 arc welder for 16 years. On admission, He complainer loss of appetite, numbness of extremities, fatigue and decrease of attention. In the test of manganese exposure indices, manganese concentrations of blood, urine and scalp hair were 5.14 microgram/dL, 13.79 microgram/l and 50.08 ppm respectively. In neurologic examination, Myerson sign was observed. In brain magnetic resonance imaging, T1WI showed symmetrical high signal intensity in basal ganglia and midbrain of three cases. Authors argued that they were developed by manganese exposure, and we considered that follow up study would be necessary.

Magnetic Resonance Lmaging and Surgical Decision of the Degenerative Cervical Spine Lesions

We undertook a retrospective analysis of 30 patients admitted to the Department of Neurosurgery Dongsan Medical Center Keimyung University utilizing Magnetic Resonanace Imaging(MRI) to make diagnosis and surgical indication of degenerative cervical spine lesions. All patients were taken T1 Weighted Image(T1W1) T2 Weighted Image(T2WI) and gradient echo image on 2.0 Tesla unit. Pre- and postoperative MRI were obtained seven of 15 cases with myelopathy. All patients could be evaluated the extent and degree of disc herniation, osteophytes and cord compression. A focal area of High-Signal-Intensity(HIS) was observed on T2WI in 15 patients with mydlopathy predominantly. HIS diminished postoperatively in the patients who improved clinically and remained the same in one case whose condition remained unchanged after decompression. We think MRI with high resolution images in the initial procedure of choice in decision-making of patients with degenerative cervical spine lesion. Furthermore HIS of the spinal cord produced by compressive lesions appears to be an important indicator for predicting prognosis of patients with myelopathy.

Magnetic Resonance Imaging(MRI) and Surgical Decision of Traumatic and Degenerative Cervical Spine Lesions

We undertook a retrospective analysis of 20 patients admitted to the Department of Neurosurgery, Dongsan Medical Center, Keimyung University, utilizing Magnetic Resonance Imaging(MRI) to make diagnosis and surgical indication of traumatic and degenerative cervical spine lesions. All patients were taken T1 Weighted Lmage(T1WI), T2 Weighted Image(T2WI) and Gradient echo on 2.0 Telsa unit. Pre-and postoperative were obtained in 4 cases with degenerative lesion. All patients could be evaluated the extent and degree of soft tissue injury including intramedullary contusion or hemorrhage, acute or chronic disc herniation, osteophytes, cord compression, epidural/paravertebral hematoma, ligamentous avulsion, fractures and malalignment. High-signal-intensity(HSI) was observed on T2WI in 10 patients with myelopathy. HSI diminished postoperatively in the patients who improved clinically, and remained the same in one case whose conditions remained uncharged after decompression. Preliminary experience with Magnetic Resonance Imaging(MRI) in the evaluation of traumatic and degenerative cervical spine lesions reveal many advantages over the computed tomoography, plain radiographs and myelography. Futhermore, HSI of the spinal cord produced by compressive lessions appears to be an important indicator for predicting prognosis.